Sep 1, 2015 - Accelerated idioventricular rhythm (AIVR) during anesthesia has been described in .... Atrioventricular (AV) junctional rhythm, another con-.
Nakanishi et al. JA Clinical Reports (2015) 1:12 DOI 10.1186/s40981-015-0016-3
CASE REPORT
Open Access
Accelerated idioventricular rhythm observed under total intravenous anesthesia using remifentanil, propofol, and rocuronium Mika Nakanishi*, Kaoru Masumo, Takako Oota, Takeshi Kato and Toshihiro Imanishi
Abstract Accelerated idioventricular rhythm (AIVR) during anesthesia has been described in several drug toxicity such as from cocaine, halothane, desflurane, and propofol. We present the case of a man who developed episodes of AIVR observed under total intravenous anesthesia (TIVA) using remifentanil, propofol, and rocuronium. AIVR during anesthesia was a benign phenomenon, and further examinations after surgery showed no structural heart disease and the daily occurrence of idioventricular arrhythmias. This case suggests that the suppression of sinus and atrioventricular nodal function and the autonomic imbalance caused by propofol and remifentanil may induce AIVR with greater frequency. Keywords: Accelerated idioventricular rhythm; Total intravenous anesthesia; Remifentanil; Propofol
Background Accelerated idioventricular rhythm (AIVR) is a ventricular rhythm comprising three or more consecutive monomorphic beats, with a gradual onset. The discharge rate of the ectopic focus is similar to the sinus rate and between 50 and 120 bpm (isorhythmic). The ectopic focus manifests when the sinus rate slows down (below that of the ectopic focus) or when the ectopic focus accelerates above its intrinsic rate by 30–40 bpm [1]. Nine clinical features are helpful in distinguishing AIVR from ventricular tachycardia (VT): chance discovery; no symptoms; no hemodynamic effects;
